In almost all recent polling, voters say health care is their number one concern. Voters also trust Democrats more than Republicans on the issue.
But why?
Obamacare is the most flawed health system Americans ever created. If you combine the average premium and the average deductible people faced last year, a family of four with Obamacare insurance had to spend $25,000 before getting any benefits from their Obamacare plan. And in most places, the best doctors and the best hospitals are not included in Obamacare plans’ narrow networks.
By contrast, President Donald Trump, in one example, let employers give their employees individually-owned insurance they could take with them, from job to job and in and out of the labor market.
So why do Democrats do so much better than their Republican rivals when voters think about health care? One reason is Democrats are much better at following five rules for how successful candidates should talk about the subject.
Talk Benefits, Not Process
Sen. Bernie Sanders is a master at discussing benefits instead of how those benefits are created. Everyone who hears “Medicare for All” immediately thinks they will get first-rate care, mainly paid for by someone else.
Sanders rarely makes the mistake of talking about how we would get 156 million people from employer plans to a Medicare-for-all plan or who would pay the taxes to fund all of that.
Republicans, by contrast, almost always talk about how they want to reform things, never about how anyone would benefit. For example, the Republican alternative to Obamacare (which almost passed Congress) would have sent all the Obamacare money to the states in the form of a block grant.
How would a block grant lower anyone’s deductible or give them access to better care? Since that was never explained, it was anyone’s guess.
Talk People, Not Rules
Democratic talking points almost always focus on preexisting conditions, the high cost of drugs, or other real problems faced by real people. Republicans, by contrast, want to allow association health plans, insurance across state lines, the elimination of certificate-of-need laws, and using antitrust laws to go after hospital conglomerates, all commendable ideas.
These Republican ideas are commendable, but how do they help people? You can be forgiven if the answer isn’t obvious.
Focus on Voters
Obamacare was originally designed to insure the uninsured, and that’s how the Democrats initially tried to sell it. But then Sen. Chuck Schumer discovered a very important fact: almost everyone who votes already has insurance. That meant Obamacare would spend billions of dollars on people who don’t vote.
So, on the eve of passage, Democrats made a mid-course messaging correction. From that point on, their every speech about Obamacare focused on working families. These were voters who might worry about being denied coverage because of a preexisting condition if they retired or became too sick to work and had to turn to the individual insurance market.
Never mind that preexisting condition denials rarely ever happened. Democrats quickly learned how to talk to people whose votes they needed.
Republicans, by contrast, miss just about every opportunity that comes their way. While the Obamacare exchanges have faced one embarrassing problem after another, there is a Republican-created exchange that works really well. It’s called Medicare Advantage. Democrats used to attack this program, but since it now serves about 40 percent of all seniors and is really popular, they don’t talk about it at all.
Seniors vote in higher percentages than any other age group, and Republicans could be bragging about the program they created and how much better it works than Obamacare.
Have you ever heard them do that? I haven’t.
Keep It Simple
Successful candidates advocate changes that are easy to understand and obviously different from an opponent’s position. Sometimes Republican candidates say they advocate high-quality, low-cost health care. The problem? Democrats advocate the same things.
Sometimes Republicans say the two parties agree on goals but disagree on how to get there. The problem? If the Democrat solution is simple and the Republican solution is complicated, Democrats win.
Suppose a Republican runs against government policies that create outrageously high out-of-pocket exposure and close off access to the best doctors. Most voters will know exactly what problems are being addressed and which party created them.
Resist Special Interest Pressure
As author Steven Brill has documented, Obamacare was created by special interests. Big Insurance, big Pharma, big hospitals, and big business—they all sat around a table and designed the whole program. Without their participation, Obamacare would not have passed.
Yet, Democrats rarely hesitate to bite the hand that feeds them if there is a political advantage in doing so. In no time at all, such terms as “greedy drug companies” and “greedy insurers” cropped up in their speeches.
Republicans, by contrast, are hampered by misplaced loyalties. Republicans never held a single hearing on Obamacare’s victims. Apparently, this was at the request of insurance companies who feared Democrats would blame them for Obamacare failures if the hearings took place.
Republicans would be wise to learn what Democrats seem to know instinctively: the special interests have no lasting loyalties to either party.
Put Rules to Work
For the past two years, more than 70 think tanks and advocacy organizations have been working on what health reforms are most needed.
Families need to be able to buy affordable health insurance that meets their medical and financial needs and gives them access to the doctors and hospitals they need.
John C. Goodman, Ph.D. (johngoodman@goodmaninstitute.org) is co-publisher of Health Care News and president and founder of the Goodman Institute for Public Policy Research, which published an earlier version of this article on September 15, 2021. Reprinted with permission.
